Impact of Fatigue on Anaesthesia Providers

Fatigue is being recognised as a workplace hazard of increasing concern. It is a significant problem for anaesthesiologists who have long working hours and irregular schedules. Fatigue negatively impacts vigilance, communication, and teamwork and shows decreased performance during psychomotor testing. However, its impact on real-life performance is uncertain.

Fatigue is a complex issue with many definitions proposed in scientific literature. It is commonly defined as a state of reduced mental or physical capability caused by sleep deprivation, extended wakefulness, disrupted circadian rhythm, or increased workload. Even though fatigue is not the same as sleepiness, tiredness, or exhaustion, these terms are often used interchangeably in scientific literature.

The practice of medicine involves long hours and overnight work. Recently, fatigue has received more attention from consultants and residents. Efforts have been made to regulate work hours, but the impact on patient safety, resident education, and fatigue are not well understood due to limited evidence.

A scoping review was conducted on fatigue among anaesthesia providers, exploring the prevalence of fatigue and its impact on performance. The initial database search found 118 studies, and 30 were selected for review. Out of 30 reviewed studies, eight focused on the prevalence of fatigue in anaesthesia providers, and 22 explored the impact of fatigue on their performance. 

The eight identified studies show that fatigue is a significant problem for anaesthesia providers. Up to 60.8% of anaesthesia providers experience severe excessive daytime sleepiness, and fatigue is a common workplace issue for 73.1% of them. Fatigue has negative impacts on physical health (73.6%), psychological well-being (71.2%), and personal relationships (67.9%). Fatigue negatively affects medication errors, vigilance, and performance during laboratory psychomotor testing for anaesthesia providers. In addition, it reduces non-technical skills (especially communication and teamwork) and worsens mood. 

Overall, as per the findings of this review, fatigue is a widespread issue that anaesthesia providers need to address. A decline in non-technical skills, increased medication errors, loss of attention, and psychomotor decline can result in poor performance and pose a risk to patients. The review does not clarify the impact of fatigue on technical skills and executive function in real-life situations. However, it is evident that strategies to address fatigue and its effects must be studied at the personal and organisational levels. Anaesthesiologists also need increased awareness of the potential impact of fatigue.

Source: British Journal of Anaesthesia

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